Antioch Assistance Application
In order to request assistance from the Antioch Church Benevolence Fund, the application for assistance must be filled out in its entirety. The Benevolence Fund Team may require additional information to make an appropriate decision.  Please note that currently Antioch Church is only able to offer assistance to people in our body.  If you are hoping to help someone outside of the Antioch body, please go to your Life Group leader first.
Email address *
Applicant's Information
If you are applying for assistance, please fill out this section for yourself.  If you are applying for someone else, please fill in their information in this section.
Full Name *
Your answer
Contact Email *
Your answer
Street Address *
Your answer
City, State, and Zip Code *
Your answer
Mobile Phone *
Your answer
Marital Status *
Are you applying for yourself or on the behalf of another? *
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